Tag Archives: American Medical Association

Joseph Serna reports for The Los Angeles Times that public health officials across the West Coast are urging medical professionals to look out for cases of ocular syphilis – a sexually transmitted disease that can cause blindness.

On March 5, 2015, the Los Angeles County Department of Public Health issued an advisory for primary and eye-care providers to look out for symptoms associated with ocular syphilis, which is usually a complication of primary or secondary syphilis infections.

Two recent suspected cases in Los Angeles are added to the more than a dozen reported cases of ocular syphilis between Seattle and San Francisco, most of them among homosexual men. Some of the patients also are HIV positive, including six in San Francisco. In Seattle, two of the patients went blind.

In a statement, president of AIDS Healthcare Foundation Michael Weinstein calls for medical professionals to do more: “These new cases … highlight the importance of ongoing, regular check-ups for sexually active individuals who feel they may be at risk, particularly men who have sex with men.”

According to the Centers for Disease Control and Prevention, California’s syphilis rate is second in the country behind only Georgia. Los Angeles also had the highest number of primary and secondary cases of syphilis of any county in the U.S. in 2013, the CDC reported.

Meanwhile, the FDA’s decades-long ban on homosexual men as blood donors is opposed by the American Medical Association, despite the fact that according to the FDA, “gay men represent 61 percent of all new HIV infections in the U.S.” (ABC News)

The expression “death panel” was coined in August 2009 by former Alaska governor Sarah Palin, during the nationwide debate about the proposed Patient Protection and Affordable Care Act, better known as Obamacare.

Referring to Section 1233 of HR 3200, the House version of Obamacare, which would have paid physicians for counseling Medicare patients about living wills, advance directives, and end-of-life care options, Gov. Palin expressed her concern that the proposed legislation would create a “death panel” of unelected bureaucrats who would decide whether Americans—such as her elderly parents or her child, Trig, with Down syndrome whom the vicious Left said she should have aborted —were “worthy of medical care.”

The Left immediately demonized Palin and derided her claim as the “death panel myth.” Nevertheless, “death panel” instantly became a meme that penetrated through the minutiae of the 906-page long Obamacare legislation, arousing much public concern. As a result, the provision to pay physicians for providing voluntary counseling was removed from the Obamacare law that Congress passed and Obama signed into law in 2010.

But that’s not the end of the story, for Sarah’s “death panel” is back, via Medicare.

Now that Obamacare is (more or less) firmly in place and talk of “death panels” has subsided, Medicare is trying again.

The New York Timesreports that next year, Medicare may begin covering “end-of-life discussions” if it approves a recent request from the American Medical Association (AMA), the largest association of physicians and medical students in the United States. One of AMA’s roles is to create billing codes for medical services which are used by doctors, hospitals and insurers. It recently created codes for end-of-life conversations and submitted them to Medicare.

Dr. Barbara Levy, chair of the AMA committee that submits reimbursement recommendations to Medicare, said, “We think it’s really important to incentivize this kind of care. The idea is to make sure patients and their families understand the consequences, the pros and cons and options so they can make the best decision for them.”

The Centers for Medicare and Medicaid Services (CMMS), which runs Medicare, would not discuss whether it will agree to cover end-of-life discussions; its decision is expected this fall. But the agency often adopts AMA recommendations, which are developed in meetings attended by CMMS representatives.

If Medicare adopts the change, its decision will also set the standard for private insurers, encouraging many more doctors to engage in these conversations.

Wanting to avoid situations in which they have to decide for incapacitated patients who have no family or state preference, some doctors already conduct “end of life” conversations for free (i.e., unreimbursed) or shoehorn them into other medical visits.

Experts say if Medicare covers end-of-life counseling, that could profoundly affect the American way of dying. But the impact would depend on how much doctors are paid, the allowed frequency of conversations, whether psychologists or other nonphysicians would conduct them, and whether the conversations must be in person or could include phone calls with long-distance family members. Paying for only one session and completion of advance directives would have limited value, experts say.

Susan Pisano, a spokeswoman for the trade association America’s Health Insurance Plans, says some private insurers already are reimbursing doctors for “end of life counseling.”The industry, which usually uses Medicare billing codes, already had created its own code under a system that allows that if Medicare does not have one, and more insurance companies are using it or covering the discussions in other ways, including:

This year, Blue Cross Blue Shield of Michigan began paying an average of $35 per conversation, face to face or by phone, conducted by doctors, nurses, social workers and others.

Cambia Health Solutions, which covers 2.2 million patients in Idaho, Oregon, Utah and Washington, started a program including end-of-life conversations and training in conducting them.

Excellus Blue Cross Blue Shield of New York does something similar, reimbursing doctors $150 for an hourlong conversation and $350 for two hours.

End-of-life planning has also resurfaced in Congress. Two recent bipartisan bills would have Medicare cover such conversations, and a third, introduced by Senator Tom Coburn (R-Oklahoma), would pay Medicare patients for completing advance directives.

Burke Balch, director of the Powell Center for Medical Ethics at the National Right to Life Committee, said in a statement that many doctors believed in “hastening death for those deemed to have a ‘poor quality of life.’ ” If Medicare covers advance care planning, he said, that plus cost-saving motivations will pressure patients “to reject life-preserving treatment.”

Although “end of life” conversations do not lock patients into decisions and some people later change their minds in a crisis, evidence suggests that those discussions do make a difference. One study found that cancer patients who previously discussed end-of-life preferences with doctors more often received care matching those wishes. Other studies suggest planning lowers stress in patients and families.

What do you think?

Are you concerned that, if approved by Medicare, some doctors and non-physicians might use “end of life” discussions to sway the elderly toward an earlier death?

Once approved by Medicare, such discussions most likely will spread to Medicaid.

I’m always in favor of everyone taking charge of our wellbeing, being maximally informed about our medical condition and prognosis, and thoroughly thinking through our end-of-life scenarios by having a will and advance directives, and appointing a trusted family member with medical power-of-attorney. But I also fear that the federal government’s (via Medicare) institutionalizing “end of life counseling” will be another of those slippery slopes — or the proverbial frog in the slowly-heating pot of water — at which our government has proven itself to be a master.

Despite House Speaker John Boehner’s huffing and puffing, Obamacare (Patient Protection and Affordable Care Act) is a reality.

The Nov. 6, 2012, elections reelected Obama to the White House and not only retained, but added to the Democratic majority in the U.S. Senate. Even before that, the Supreme Court in a 5:4 decision, already had ruled that Obamacare is constitutional and that the requirement of Americans to obtain health insurance or be penalized is merely a tax.

So, unless you’re in deep denial, Obamacare is a reality. FOTM has published posts on the Obamacare taxes coming our way. But what about another grave concern of ours — that of Obamacare death panels? Is the notion mere political hyperbole, or is it a real threat?

To answer that question, let’s look at two pieces of information.

ONE

The first is a statement by former president of the American Medical Association (AMA) Dr. Donald Palmisano, that Obamacare death panels are not a fantasy, but that such rationing panels pose an “immediate danger to seniors.”

In a Daily Caller column, Palmisano wrote that Obamacare’s Independent Payment Advisory Boards (IPAB), tasked with keeping Medicare expenses under control, would have little oversight as they deal with the disproportionate cost burden from elderly Americans with greater medical needs. The result “will essentially mean rationed care” for America’s elderly.

Palmisano wrote: “The 15 officials who will make up the board will not only be empowered to make what is expected to be billions of dollars’ worth of cuts to Medicare every year, but will be required to do so when spending exceeds targeted rates. IPAB’s recommended cuts will become law unless a supermajority in Congress vetoes the board’s proposal and creates its own cost-cutting proposal of equal size — an unlikely scenario even in the most harmonious of political times.”

Although the panels are expected to focus on cutting payments to the doctors themselves, Palmisano said that Medicaid providers are already being sucked dry, and warned that a more brutal form of rationing, using adjustments based on “quality of life” as already practiced in Great Britain, was likely in store.

“IPAB may eventually be allowed to resort to Great Britain’s chosen rationing methods and refuse to provide certain effective treatments to patients who need them based on costs and patients’ remaining ‘quality adjusted life years.’ Though the law currently forbids IPAB from engaging in such behavior, there is little reason to believe these rules won’t be changed — or at least stretched — down the road as costs continue to balloon and political dynamics change,” he wrote.

Palmisano warned that unless Congress undertakes a full repeal of Obamacare instead of piecemeal efforts, the most dangerous parts of the law, such as IPAB, will not be excised: “[I]f Congress misses what could be its last chance to eliminate IPAB — one of the most egregious aspects of the law — it will be doing a disservice to seniors who need good medical care now and in the near-term future.”

TWO

In his column, Palmisano warned that Obamacare’s IPAB “may eventually be allowed to resort to Great Britain’s chosen rationing methods and refuse to provide certain effective treatments to patients who need them based on costs and patients’ remaining “quality adjusted life years.” Here’s a recent shocking example of “death panels” in the UK — the Liverpool Care Pathway.

There’s no crystal ball where we can see our future of national healthcare under Obamacare. However, there’s a very close model in the United Kingdom’s National Health Service (NHS). In fact, while we ponder the future of death panels and rationing of healthcare in the US, the UK is living it—and in many cases dying from it. So we can look at the NHS to see our future under Obamacare. […]

The Liverpool Care Pathway (LCP) in the UK is a healthcare service that’s used when death is imminent, and it incorporates heavy doses of morphine to deal with what would otherwise be uncontrolled pain. It may seem to be a compassionate and empathetic notion, until you realize the system is being abused to serve as a fast-track pipeline to euthanize the most vulnerable patients.

What began as an effort to relieve suffering is now ending lives at a frightening pace. Here’s how the numbers play out:

Only 2–5% of patients require this level of sedation to control pain.

Yet, the LCP has been involved in the deaths of 130,000 patients who were elderly, terminally ill, or seriously ill but not dying.This is 29% of the 450,000 NHS deaths each year.

At many hospitals, over 50% of the patients who had died had been put on LCP.

[…] Assumptions are being made about what treatments are considered “futile” […] as a way to save money by limiting care to those who need it most.

The evidence is disturbing. Cancer patients are being put at the back of the line for routine services like x-rays and antibiotics. Surgeries for hip replacements, cataracts, and varicose veins are being rationed. Doctors are resorting to prescribing drinking water for neglected elderly patients to stop them from dying of thirst in the hospital. This method of dehydration and starvation has been used to end the lives of babies in a neonatal unit. There are numerous cases where patients are being killed who would otherwise be able to recover and live if only given proper treatment and essential nourishment.

When you follow the money trail, it leads to over $19 million that has been given as awards to trusts for hospitals that have hit their targeted number of patients put into LCP.It’s simply a fact that the centralization of healthcare will inevitably lead to dangerous rationing of care and perilous decisions surrounding quality of life.

Don’t believe for a moment that this couldn’t happen to you in America.The US Supreme Court upheld the constitutionality of Obamacare, and the re-election of Barack Obama ensures this government-controlled behemoth will soon be breathing down your neck. It’ll likely be even worse considering proponents of Obamacare admitted from the beginning that the government isn’t close to funding all the healthcare expectations of Americans.

If you don’t want faceless government bureaucrats make life-or-death decisions for you, Mattes urges us to do two things:

Doctors get rid of patients for missed appointments, rude or threatening behavior, and nonpayment of bills. More and more, there is a new reason.

American babies are now given 25 different vaccines in the first 15 months of life, including for Hepatitis B, which is a sexually transmitted disease in the United States. Some parents opt out of some or all of those shots. For that, they now risk being dismissed as a patient by their physician.

Anita Manningreports for USA Today, Nov. 14, 2011, that a survey of 900 pediatricians in 9 Midwestern states found that 21% have discharged families for refusing vaccination. About 60% said one in 20 families in their practice refused or requested altered vaccine schedules; 4% said a majority did.

The survey findings were reported last month at a meeting of the Infectious Diseases Society of America, by Thomas Tryon, a pediatrician at Children’s Mercy Hospitals and Clinics in Kansas City, Mo.

Vaccine safety has been the subject of escalating controversy in recent years as the number of vaccines recommended for children increases and the diseases they prevent fade into the far reaches of memory. Some parents avoid giving their children some or all vaccines because they believe vaccines are linked to rising rates of developmental disorders such as autism or may cause other health problems.

Pediatricians spend a lot of time reassuring parents and referring them to information on the safety and value of vaccines, Tryon says, but when parents persist, doctors have to consider the safety of their other patients.

For years, Tryon says, he was flexible with parents concerned about vaccines. What changed his mind was a family that refused to vaccinate their toddler, then had a second baby. Both got pertussis, or whooping cough, which can be prevented by the DTaP (diphtheria-pertussis-tetanus) vaccine. “In an 18-month-old, pertussis is a bad disease,” he says. “In a 6-week-old, it could be fatal.”

He was frustrated not only because the illnesses could have been avoided, but also because the family had “exposed everyone in my waiting room.” At that point, he says, “I said I can’t take this risk anymore.”

He instituted a policy that if, after counseling and discussing scientific evidence on vaccine safety and protective benefits, parents still refuse vaccines, they’re out. He notifies them by mail and gives them 30 days to find a new pediatrician.

The sheer number of vaccines given to children — 25 shots in the first 15 months of life — has caused some parents to worry that so much stimulation could overwhelm young immune systems. But the American Academy of Pediatrics says that studies have shown those fears to be groundless, and that spreading out shots over a longer period of time leaves kids needlessly vulnerable to infectious diseases such as polio or measles.

Many doctors see the issue as a matter of public health and make their policies clear to new patients at the outset.

Pediatrician Raymond Cattaneo of Kansas City, Mo., has a strict immunization policy — no refusals and no alternative schedules. Anything else, Cattaneo says, would be “allowing patients to decide something that was not right.” Although the policy met with some resistance, with a few patients being very upset — one family even called a local station, “overwhelmingly we were supported.”

On the center’s website, there is a “vaccine freedom wall,” where parents post stories of “being thrown out of doctor’s offices or being harassed for trying to make informed decisions about vaccines,” she says. A Facebook page, Proud Parents of Unvaccinated Children, has more than 7,300 fans.

New York City pediatrician Lawrence Pavelsky works with families who have a child with chronic illness, to improve their health without pharmaceuticals. When patients come to him, he says, “we talk about nutrition, sleep, development, vaccines, ways in which kids get sick and why and how to get them well if they are sick” without using vaccines or medication. He believes doctors who vaccinate children are working from information that is simply wrong.

“I did my own research,” he says. “Over the last 14 years, I have found that some or even a majority of the information I was taught in medical school was either false, incomplete or had flawed reasoning.”

The American Medical Association has guidelines for when it’s appropriate for a doctor to dismiss a patient.A doctor cannot legally dismiss a patient for race, religion, disability, sexual orientation, HIV status or other category protected under anti-discrimination laws, or in the middle of ongoing care. The doctor must give written notice and continue care for a period, usually 30 days, during which the patient can find a new doctor.